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Healthcare - Care Review Clinician I

Remote:

Full Remote

Contract:

Full time

Salary:

81 - 81K yearly

Experience:

Junior (1-2 years)

Work from:

New York (USA), United States

Offer summary

Qualifications:

1-2 years' experience in UM, NY State License as LPN or RN, Experience with MCG guidelines, Familiarity with Medicaid/MLTC members.

Key responsabilities:

Conduct clinical reviews for MLTC members
Handle denials and partial denial notifications
Manage personal queue and productivity expectations
Participate in interdisciplinary teams (IDTs)
Meet performance goals of 30 cases daily after training

LanceSoft, Inc. XLarge https://www.lancesoft.com/

1001 - 5000 Employees

See more LanceSoft, Inc. offers

Job description

Job Tittle: Care Review Clinician I
Job Location: 100% Remote
Estimated Length of Assignment: 3+ Months
Est. Pay Range: $42/hr on W2
Work Type: Onsite

Job Description:
All UM standard/ expedited Inpatient, Outpatient and Custodial Care clinical reviews for MLTC members.

Must Have Skills:
Must have experience in UM, experience with Turnaround Timeframes, good with computer systems and be able to learn a new system, have done clinical reviews and processed denials and partial denial determinations, know MCG and can use it, case presentation for medical reviews, know Medicaid/ Medicare guidelines. Bi-lingual Spanish, Bengali or Mandarin. - PREFERRED! NOT Mandatory.

Please ensure that candidates have experience with actually reviewing for Medicaid/ MLTC members not Medicare or IP reviews as those are very different with a different workflow and process. Candidates must be aware that this is a fast-paced environment with a Turnaround Timeframe of 3 business days on average for our std requests 72 hours urgent/expedited requests.

Day to Day Responsibilities:
All UM standard Inpatient, Outpatient and Custodial Care processes and workflows for any requests, verbal notifications for denials/partial denials to both member and provider, participation in IDTs, personal queue management and clinical reviews, meeting expected productivity and performance Productivity expectations are set a by Molina Enterprise Clinical Services based on the local Client time studied performance. Standard full capacity and performance reviews expectations is 30 cases a day – there will be a 6-8 week ramp up period to full capacity post successful completion of New hire and Client specific training.

Required Years of Experience:
At least 1-2 years’ experience in UM.

Required Licensure / Education:
Licensure required is a NY State License Practical Nurse or Registered Nurse -LPN NY & NY RN